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Does Back Pain Go Away on Its Own?

Eighty percent of people suffer from back pain at some point in their lives. Back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. Most cases of back pain are mechanical or non-organic—not caused by serious conditions, such as inflammatory arthritis, infection, fracture, or cancer.

What Causes Back Pain?

The back is a complicated structure of bones, joints, ligaments, and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.

Back injuries are a part of everyday life, and the spine is quite good at dealing with these often "pulled" muscles. These very minor injuries usually heal within 1 or 2 days. Some pain, however, continues. What makes it last longer is not entirely understood, but researchers suspect that the reasons may include stress, mood changes, and the fear of further injury that may prevent patients from being active. In addition, sometimes a painful injury or disease changes the way the pain signals are sent through the body, and, even after the problem has gone away or is inactive, the pain signals still reach the brain. It is as if the pain develops a memory that keeps being replayed.

Will Back Pain Go Away on Its Own?

Until recently, researchers believed that back pain would heal on its own. We have learned, however, that this is not true. A recent study showed that when back pain is not treated, it may go away temporarily, but will most likely return. The study demonstrated that in more than 33% of the people who experience low back pain, the pain lasts for more than 30 days. Only 9% of the people who had low-back pain for more than 30 days were pain free 5 years later.

Another study looked at all of the available research on the natural history of low-back pain. The results showed that when it is ignored, back pain does not go away on its own, but continues to affect people for long periods after it first begins

What Can I Do to Prevent Long-Term Back Pain?

If your back pain is not resolving quickly, visit your doctor of chiropractic. Your pain will often result from mechanical problems that your doctor of chiropractic can address. Many chiropractic patients with relatively long-lasting or recurring back pain feel improvement shortly after starting chiropractic treatment. The relief is often greater after a month of chiropractic treatment than after seeing a family physician.

Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.

How Can I Prevent Back Pain?

• Don't lift by bending over. Instead, bend your hips and knees and then squat to pick up the object. Keep your back straight, and hold the object close to your body.
• Don't twist your body while lifting.
• Push, rather than pull, when you must move heavy objects.
• If you must sit for long periods, take frequent breaks and stretch.
• Wear flat shoes or shoes with low heels.
• Exercise regularly. An inactive lifestyle contributes to lower-back pain.

What Should I Tell My Doctor of Chiropractic?

Before any treatment session, tell your doctor of chiropractic if you experience any of the following:

• Pain goes down your leg below your knee.
• Your leg, foot, groin, or rectal area feels numb.
• You have fever, nausea, vomiting, stomach ache, weakness, or sweating.
• You lose bowel control.
• Your pain is caused by an injury.
• Your pain is so intense you can't move around.
• Your pain doesn't seem to be getting better quickly.

Your neck, also called the cervical spine, begins at the base of the skull and contains seven small vertebrae. Incredibly, the cervical spine supports the full weight of your head, which is on average about 12 pounds. While the cervical spine can move your head in nearly every direction, this flexibility makes the neck very susceptible to pain and injury.

The neck's susceptibility to injury is due in part to biomechanics. Activities and events that affect cervical biomechanics include extended sitting, repetitive movement, accidents, falls and blows to the body or head, normal aging, and everyday wear and tear. Neck pain can be very bothersome, and it can have a variety of causes.

Here are some of the most typical causes of neck pain:

Injury and Accidents: A sudden forced movement of the head or neck in any direction and the resulting "rebound" in the opposite direction is known as whiplash. The sudden "whipping" motion injures the surrounding and supporting tissues of the neck and head. Muscles react by tightening and contracting, creating muscle fatigue, which can result in pain and stiffness. Severe whiplash can also be associated with injury to the intervertebral joints, discs, ligaments, muscles, and nerve roots. Car accidents are the most common cause of whiplash.

Growing Older: Degenerative disorders such as osteoarthritis, spinal stenosis, and degenerative disc disease directly affect the spine.

• Osteoarthritis, a common joint disorder, causes progressive deterioration of cartilage. The body reacts by forming bone spurs that affect joint motion.
• Spinal stenosis causes the small nerve passageways in the vertebrae to narrow, compressing and trapping nerve roots. Stenosis may cause neck, shoulder, and arm pain, as well as numbness, when these nerves are unable to function normally.
• Degenerative disc disease can cause reduction in the elasticity and height of intervertebral discs. Over time, a disc may bulge or herniate, causing tingling, numbness, and pain that runs into the arm.

Daily Life: Poor posture, obesity, and weak abdominal muscles often disrupt spinal balance, causing the neck to bend forward to compensate. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Postural stress can contribute to chronic neck pain with symptoms extending into the upper back and the arms.

Chiropractic Care of Neck Pain

During your visit, your doctor of chiropractic will perform exams to locate the source of your pain and will ask you questions about your current symptoms and remedies you may have already tried. For example:

• When did the pain start?
• What have you done for your neck pain?
• Does the pain radiate or travel to other parts of your body?
• Does anything reduce the pain or make it worse?

Your doctor of chiropractic will also do physical and neurological exams. In the physical exam, your doctor will observe your posture, range of motion, and physical condition, noting movement that causes pain. Your doctor will feel your spine, note its curvature and alignment, and feel for muscle spasm. A check of your shoulder area is also in order. During the neurological exam, your doctor will test your reflexes, muscle strength, other nerve changes, and pain spread. In some instances, your chiropractor might order tests to help diagnose your condition. An x-ray can show narrowed disc space, fractures, bone spurs, or arthritis. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show bulging discs and herniations. If nerve damage is suspected, your doctor may order a special test called electromyography (an EMG) to measure how quickly your nerves respond.

Chiropractors are conservative care doctors; their scope of practice does not include the use of drugs or surgery. If your chiropractor diagnoses a condition outside of this conservative scope, such as a neck fracture or an indication of an organic disease, he or she will refer you to the appropriate medical physician or specialist. He or she may also ask for permission to inform your family physician of the care you are receiving to ensure that your chiropractic care and medical care are properly coordinated.

Neck Adjustments

A neck adjustment (also known as a cervical manipulation) is a precise procedure applied to the joints of the neck, usually by hand. A neck adjustment works to improve the mobility of the spine and to restore range of motion; it can also increase movement of the adjoining muscles. Patients typically notice an improved ability to turn and tilt the head, and a reduction of pain, soreness, and stiffness.

At Ash Chiropractic and Wellness, we will develop a program of care that may combine more than one type of treatment, depending on your personal needs. In addition to manipulation, the treatment plan may include mobilization, massage or rehabilitative exercises, or something else.

For decades, osteoarthritis has been considered a part of aging. But not anymore. Recent research points out that older people don't have to suffer from osteoarthritic pain. And, surprisingly, people much younger than 65 can develop osteoarthritis.

What Is Osteoarthritis?

Osteoarthritis (OA), or degenerative joint disease, affects more than 20 million Americans and is more common in women than in men. The disease affects the cartilage—slippery tissue on the ends of bones that meet in a joint. Normally, cartilage helps bones glide over one another. In an OA patient, however, the cartilage is broken down and eventually wears away. As a result, instead of gliding, bones rub against each other, causing pain, swelling, and loss of motion.

Although the majority of patients with OA are 65 and older, recent research shows that osteoarthritis is not a by-product of aging. Family history of OA, being overweight, lack of exercise, and prior joint injuries are suggested as OA risk factors.

How Is Osteoarthritis Diagnosed?

OA is diagnosed through a combination of clinical history, patient examination, and x-rays. Other tests, such as drawing fluid from the joint, are sometimes used.

The signs of OA include:

• Steady or intermittent joint pain
• Joint stiffness after sitting, sleeping, or otherwise not moving for a long time
• Swelling or tenderness in the joints
• A crunching feeling or the sound of bones rubbing against each other.

If you experience any of these signs, consult your health care provider. While the diagnosis is relatively easy to make, it is often harder to establish whether or not OA causes the patient's symptoms. That's why the treating doctor needs to not only make the diagnosis, but also rule out other disorders and conditions that can make the symptoms worse.1 Timely diagnosis and treatment can help manage pain, improve function, and slow the degeneration.

Should Osteoarthritis Patients Exercise?

Exercise is one of the best forms of OA treatment—and prevention. It strengthens the muscular support around the joints and improves and maintains joint mobility and function. In addition, exercise helps control weight and improves the patient's mood and outlook—important factors influencing the severity of the symptoms.

If you suffer from OA, consider the following exercise tips:

• Low-impact or non-weight-bearing activities, such as walking, stationary training, and light weight training work best for OA patients.
• Use strengthening exercises if the key muscle groups that relate to the function of the joints are weakened by the degeneration.
• If you are overweight, start exercising carefully, so as not to put too much stress on the knee and ankle joints.
• Stair climbing, water aerobics, Theraband workouts, and similar exercises will help to keep the joints mobile without straining them.
• Learn to read the body's signals and know when to stop, slow down, or rest.

How Can Your Chiropractor Help?

Doctors of chiropractic, by the nature of their work, can detect the earliest degenerative changes in the joints. They see the impact of degenerative changes in the spine, as well as in the hips, knees, and other weight-bearing joints. Doctors of chiropractic are also trained to relieve the pain and improve joint function through natural therapies, such as chiropractic manipulation, trigger-point therapy, or some massage techniques.

Doctors of chiropractic can provide exercise counseling, helping you choose exercises that are best for you. If a sore or swollen joint prevents you from exercising, talk to your doctor of chiropractic about other drug-free pain-relief options, such as applying heat or cold to the affected area. In addition, your doctor of chiropractic can help you choose proper supplements that play important roles in OA prevention and treatment.

Nutritional and Supplemental Approach to Treating Osteoarthritis

For those who would like to try supplements and nutrition as well, they are often found effective.

Glucosamine and chondroitin sulfate are the two most popular and most researched OA supplements. When taken over a period of time, they tend to reduce pain and increase function especially with knee OA. These supplements may also slow progression of the disease.

When taking supplements, remember:

• As with medications, take the right amount. Studies used 1,500 mg per day of glucosamine and 1,200 mg per day of chondroitin sulfate. If you use a different dosage, the effect will be different.
• Different products may contain a different amount of the supplement--sometimes not corresponding to what's on the label. To choose the proper supplement, consult a health care provider trained in nutrition.
• Unlike the quick effect of medications, it usually takes several weeks before you feel pain relief or improvement in function when taking a supplement.
• Supplements may not be for everyone. Chondroitin sulfate may interfere with anticoagulant medications, so if you take anticoagulants, talk to your prescribing physician before taking glucosamine and chondroitin. In addition, the supplements haven't been studied in pregnant women, so they should not take glucosamine and chondroitin.

Sciatica describes persistent pain felt along the sciatic nerve, which runs from the lower back, down through the buttock, and into the lower leg. The sciatic nerve is the longest and widest nerve in the body, running from the lower back through the buttocks and down the back of each leg. It controls the muscles of the lower leg and provides sensation to the thighs, legs, and the soles of the feet.

Although sciatica is a relatively common form of low back and leg pain, the true meaning of the term is often misunderstood. Sciatica is actually a set of symptoms— not a diagnosis for what is irritating the nerve root and causing the pain.

Sciatica occurs most frequently in people between the ages of 30 and 50 years old. Most often, it tends to develop as a result of general wear and tear on the structures of the lower spine, not as a result of injury.

What are the symptoms of sciatica?

The most common symptom associated with sciatica is pain that radiates along the path of the sciatic nerve, from the lower back and down one leg; however, symptoms can vary widely depending on where the sciatic nerve is affected. Some may experience a mild tingling, a dull ache, or even a burning sensation, typically on one side of the body. Some patients also report:

• A pins-and-needles sensation, most often in the toes or foot
• Numbness or muscle weakness in the affected leg or foot

Pain from sciatica often begins slowly, gradually intensifying over time. In addition, the pain can worsen after prolonged sitting, sneezing, coughing, bending, or other sudden movements.

What causes sciatica?

The most common cause of sciatica is irritation of the sciatic nerve in the lower back (lumbar region) due to a herniated or ruptured disc. Spinal discs are shock absorbing cushions between each vertebra that keep your spine flexible. Discs have a stronger outer ring and a soft jelly-like center, but as we age, spinal discs can deteriorate, becoming drier, flatter, and more brittle.

Frequently, the tough outer covering may develop tiny tears, which allow the jelly-like substance to seep out (rupture or herniation). The herniated disc may then press on the nerve root, causing sciatic symptoms such as pain, tingling, and weakness in the legs and feet. Nerve roots may also be irritated by the chemicals found in the discs' nucleus.

Other conditions can also put pressure on the nerve, including:

• Spinal stenosis – narrowing of the spinal canal, which places pressure on the spinal cord or the nerve roots
• Degenerative disc disease – a common part of the aging process, leading to a change in the disc shape and function, which can result in disc herniation or pain
• Pregnancy – extra weight and pressure on the spine can compress the sciatic nerve
• Trauma – a fall, car accident, or other trauma can injure the nerve roots
• Piriformis syndrome – spasm of the piriformis muscle can compress the sciatic nerve
• Spondylolisthesis – when a vertebra slips forward over another vertebra, the slip can pinch the nerve root
• Spinal tumors or infections – very rare; both can compress the sciatic nerve

In rare cases, a herniated disc may press on nerves that cause you to lose control of bladder or bowel functions. This is an emergency situation and requires an immediate call to your doctor.

How is sciatica diagnosed?

Your doctor of chiropractic will begin by taking a complete patient history. You'll be asked to describe your pain and to explain when the pain began, and what activities lessen or intensify the pain. Forming a diagnosis will also require a physical and neurological exam, in which the doctor will pay special attention to your spine and legs. You may be asked to perform some basic activities that will test your sensory and muscle strength, as well as your reflexes. For example, you may be asked to lie on an examination table and lift your legs straight in the air, one at a time.

In some cases, your doctor of chiropractic may recommend diagnostic imaging, such as x-ray, MRI, or CT scan. Diagnostic imaging may be used to rule out a more serious condition, such as a tumor or infection, and can be used when patients with severe symptoms fail to respond to six to eight weeks of conservative treatment.

What are my treatment options?

For most people, sciatica responds very well to conservative care, including chiropractic. Keeping in mind that sciatica is a symptom and not a stand-alone medical condition, treatment plans will often vary depending on the underlying cause of the problem.

Chiropractic offers a non-invasive (non-surgical), drug free treatment option. The goal of chiropractic care is to restore spinal movement, thereby improving function while decreasing pain and inflammation. Depending on the cause of the sciatica, a chiropractic treatment plan may cover several different treatment methods, including but not limited to spinal adjustments, ice/heat therapy, ultrasound, TENS, and rehabilitative exercises.

Chiropractic spinal manipulation is proven to be effective and has minimal side effects. Recently released practice guidelines published in the Annals of Internal Medicine (2007) stress a conservative approach to treating low-back pain and recommended spinal manipulation as one treatment with proven benefits.

Unless advised otherwise by your doctor of chiropractic, remain active and avoid prolonged bed rest. In the long run, inactivity can make your symptoms worse, whereas regular exercise has been shown to reduce the intensity of pain associated with sciatica.

Fortunately, 80 to 90 percent of patients with sciatica will recover without surgery. If surgery is warranted or your doctor of chiropractic feels it would be best to co-manage your condition with another provider, however, he or she will refer you to a local specialist.

An Ounce of Prevention Is Worth a Pound of Cure

While it's not always possible to prevent sciatica, consider these suggestions to help protect your back and improve your spinal health.

• Maintain a healthy diet and weight
• Exercise regularly
• Maintain proper posture
• Avoid prolonged inactivity or bed rest
• If you smoke, seek help to quit

* Use good body mechanics when lifting

Scoliosis affects 5 to 7 million people in the United States. More than a half million visits are made to doctors' offices each year for evaluation and treatment of scoliosis. Although scoliosis can begin at any age, it most often develops in adolescents between the ages of 10 and 15. Girls are more commonly affected than boys. Because scoliosis can be inherited, children whose parents or siblings are affected by it should definitely be evaluated by a trained professional.

What is scoliosis?

Because we walk on 2 feet, the human nervous system constantly works through reflexes and postural control to keep our spine in a straight line from side to side. Occasionally, a lateral (sideways) curvature develops. If the curvature is larger than 10 degrees, it is called scoliosis. Curves less than 10 degrees are often just postural changes. Scoliosis can also be accompanied by

lordosis (abnormal curvature toward the front) or kyphosis (abnormal curvature toward the back). In most cases, the vertebrae are also rotated.

In more than 80% of cases, the cause of scoliotic curvatures is unknown; we call this condition idiopathic scoliosis. In other cases, trauma, neurological disease, tumors, and the like are responsible. Functional scoliosis is often caused by some postural problem, muscle spasm, or leg-length inequality, which can often be addressed. Structural scoliosis does not reduce with postural maneuvers. Either type can be idiopathic or have an underlying cause.

What are the symptoms of scoliosis?

Scoliosis can significantly affect the quality of life by limiting activity, causing pain, reducing lung function, or affecting heart function. Diminished self-esteem and other psychological problems are also seen. Because scoliosis occurs most commonly during adolescence, teens with extreme spinal deviations from the norm are often teased by their peers.

Fortunately, 4 out of 5 people with scoliosis have curves of less than 20 degrees, which are usually not detectable to the untrained eye. These small curves are typically no cause for great concern, provided there are no signs of further progression. In growing children and adolescents, however, mild curvatures can worsen quite rapidly—by 10 degrees or more—in a few months. Therefore, frequent checkups are often necessary for this age group.

How is scoliosis evaluated?

Evaluation begins with a thorough history and physical examination, including postural analysis. If a scoliotic curvature is discovered, a more in-depth evaluation is needed. This might include a search for birth defects, trauma, and other factors that can cause structural curves.

Patients with substantial spinal curvatures very often require an x-ray evaluation of the spine. The procedure helps determine the location and magnitude of the scoliosis, along with an underlying cause not evident on physical examination, other associated curvatures, and the health of other organ systems that might be affected by the scoliosis. In addition, x-rays of the wrist are often performed. These films help determine the skeletal age of the person, to see if it matches an accepted standard, which helps the doctor determine the likelihood of progression. Depending on the scoliosis severity, x-rays may need to be repeated as often as every 3 to 4 months to as little as once every few years.

Other tests, including evaluation by a Scoliometer™, might also be ordered by the doctor. This device measures the size, by angle, of the rib hump associated with the scoliosis. It is non-invasive, painless, and requires no special procedures. A Scoliometer™ is best used as a guide concerning progression in a person with a known scoliosis—not as a screening device.

Is scoliosis always progressive?

Generally, it is not. In fact, the vast majority of scoliosis remains mild, is not progressive, and requires little treatment, if any. In one group of patients, however, scoliosis is often more progressive. This group is made up of young girls who have scolioses of 25 degrees or larger, but who have not yet had their first menstrual period. Girls generally grow quite quickly during the 12 months before their first period and if they have scolioses, the curvatures tend to progress rapidly. In girls who have already had their first periods, the rate of growth is slower, so their curves tend to progress more slowly.

What is the treatment for scoliosis?

There are generally 3 treatment options for scoliosis—careful observation, bracing, and surgery. Careful observation is the most common "treatment," as most mild scolioses do not progress

and cause few, if any, physical problems. Bracing is generally reserved for children who have

not reached skeletal maturity (the time when the skeleton stops growing), and who have curves between 25 and 45 degrees. Surgery is generally used in the few cases where the curves are greater than 45 degrees and progressive, and/or when the scoliosis may affect the function of the heart, lungs, or other vital organs.

Spinal manipulation, therapeutic exercise, and electrical muscle stimulation have also been advocated in the treatment of scoliosis. None of these therapies alone has been shown to consistently reduce scoliosis or to make the curvatures worse. For patients with back pain along with the scoliosis, manipulation and exercise may be of help.

Most people with scoliosis lead normal, happy, and productive lives. Physical activity including exercise is generally well-tolerated and should be encouraged in most cases..

Spinal Disc Problems

Eighty percent of people experience back pain, and at any one point in time, approximately 20% of the population has back pain. For many decades, doctors and scientists believed that most back pain was caused by "slipped" or "torn" discs. We now know this not to be true. Disc problems constitute only a small portion of the causes of back pain and rarely require surgery for pain relief.

What are spinal discs?

Spinal discs are a critically important part of your spinal column. Along with the vertebrae, also called the spinal bones, they perform many functions. The discs provide shock absorption, protecting the spinal cord and ensuring flexibility of the spine. They also perform other functions.

The spinal discs are essentially ligaments (structures connecting bones) that attach to the top and bottom of each vertebra. They are thick, ligament-like outer rings, also known as annuli fibrosis. Because they are arranged in an alternating pattern with the vertebrae, annuli fibrosis allow flexibility while preventing the vertebrae from moving too much and causing injury.

Inside a single annulus fibrosis is a jelly-like substance called the nucleus pulposis. It contains some proteins, but is primarily made up of water. The nucleus provides more shock absorption than does the annulus and it also acts as a fulcrum to direct the type of movement through which each vertebra travels.

What are the most common disc problems?

• A disc "bulge" results from slight tears in the outermost fibers of an annulus fibrosis. These small tears can be painful for a short time.
• A disc protrusion/extrusion, also called "herniation," is a more significant injury. It results from a complete or significant tear of the fibers of an annulus-when some of the nucleus leaks through. A herniation can also be painful and may even cause nerve compression. In the most severe cases, the spinal cord can become compressed.
• The most common disc problem suffered by adults is degenerative disc disease. This occurs when the nucleus loses water and small tears develop in it. The body then forms osteophytes (bone spurs), along the edges of the vertebra and the disc space narrows. We used to believe that this was a function of "wear and tear" as we aged. The most recent evidence shows that, most often, there is a hereditary link to the development of degenerative disc disease. Degenerative disc disease can also be caused by trauma/injury.

What are the common signs and symptoms of disc problems?

Common signs of disc problems include, but are not limited to:

• Back or neck pain
• Leg or arm pain
• Stiffness
• Tenderness of the spine and spinal muscles

How are disc problems diagnosed?

Disc problems are most often diagnosed with the use of a thorough history and physical examination, including examination of your nervous and musculoskeletal systems. Your doctor will most likely move your back and arms and legs into various positions while applying pressure to your joints.

Plain film x-rays are helpful in only some forms of disc problems. Magnetic resonance imaging (MRI) has become the mainstay for the diagnosis of disc problems, as it images the discs quite nicely. Your doctor may order an MRI if he or she feels it would be helpful in diagnosing a disc problem and determining the proper course of care for you. Most often, however, this is not necessary.

How are disc problems treated?

Luckily, in most circumstances, disc problems are easily treated with conservative interventions. Early in the course of an acute injury, your doctor of chiropractic will very likely set a goal of pain control, using several different physical modalities to reach it. Both ice and heat have shown effectiveness in managing the pain of acute low-back injury. Your doctor of chiropractic will help you determine which is most effective for you.

In addition, getting you back on your feet and moving as quickly as is safely possible is critical. Typically, the less time you spend in bed, the better off you are in terms of long-term results. You'll also need to learn not to be afraid to move. If you "baby" your back, in most cases, the long-term results will be worse.

Chiropractic spinal manipulation has also been demonstrated to be a safe and effective tool in the management of disc problems. Manipulation is especially effective when combined with therapeutic exercise.

In most circumstances, spine surgery and injections are not necessary in the management of disc problems- and they often cause more problems than they're worth. Your doctor of chiropractic will discuss all available treatment options with you and help you decide on the best course of action.

Can disc problems be prevented?

While regular exercise will help strengthen your back, research has demonstrated that staying fit and using proper body mechanics alone will not prevent injury. The National Institute for Occupational Safety and Health (NIOSH) recommends that individuals do not lift more than 50 lbs. Further, activities that require awkward or prolonged postures and repetitive activities place individuals at high risk for musculoskeletal disorders and disc problems regardless of body mechanics and fitness level. Your doctor of chiropractic can conduct an ergonomic assessment of your work and home activities to help you prevent injury.

It is also critically important to have "spinal awareness." Make a conscious effort, for example, to be aware of what posture you are maintaining when you sit, stand, lie down, work, and exercise. Lift objects with proper posture, including bending your knees, keeping the object close to your body, keeping your back straight and lifting with your legs. Never lift an object by bending over and twisting. You'll only invite a back injury.

If you experience any of the following, seek immediate medical care for a spine problem:

• Loss of bowel or bladder control
• Inability to urinate and/or defecate
• Acute loss of feeling in both buttocks and/or both arms
• Inability to walk or use your arms (often from severe acute weakness)
• Fever along with your back pain

Patients with lumbar spinal stenosis—one of the most common reasons for spinal surgery in older people—are commonly recognized by a bent-forward, shuffling posture and a characteristic small-step gait. Stenosis surgery, however, is a major procedure that is recommended only when conservative methods of care aren't effective—or when stenosis is caused by such things as tumors or accompanied by intolerable pain or severe neurological problems, such as loss of bowel and bladder function.

What is stenosis?

Spinal stenosis is created by the narrowing of the spinal canal. This narrowing may be caused by mechanical problems or by abnormalities in the aging spine. It may or may not result in low-back pain, limping, and a lack of feeling in the legs.

Stenosis is often a degenerative condition. It may exist for years without causing pain or discomfort, but a fall or an accident can trigger characteristic stenotic pain. Numerous factors can cause stenosis, such as thickened ligaments, expanding infection, abscess, a congenital or developmental anomaly, degenerative changes, vertebral fractures or dislocations, or a spinal cord tumor.

Other conditions, such as a herniated disc, can mimic stenosis. While herniated discs usually cause rapid and acute muscle spasm, discomfort caused by stenosis builds gradually. Other conditions that can be confused with stenosis include vascular claudication, peripheral vascular disease, and abdominal aortic aneurysms.

Claudication—pain triggered by walking—caused by vascular disease most often occurs after walking a fixed distance. Patients with spinal stenosis, however, walk variable distances before symptoms set in. Activities like riding a bicycle and walking up a hill can cause pain in patients with vascular claudication, but not in those with stenosis. On the other hand, standing makes pain worse for stenotic patients, while it relieves vascular claudication.

How is stenosis diagnosed?

Spinal stenosis can be diagnosed based on the history of symptoms, a physical examination, and imaging tests. An MRI is a very poor predictor of future disability in stenosis. An electrodiagnostic study is more dependable for information on a stenotic spine. To diagnose stenosis caused by an abscess or an infection, blood work analyzed by a laboratory may be required, while vertebral tumors and spinal tumors require finely tuned imaging.

Although degeneration is the most common cause of the condition, spinal stenosis can also result from longterm steroid use. Degenerative stenosis also has multiple contributing factors, including disc degeneration, disc bulging, bone spur formation around the vertebrae and the facets, thickening of the soft tissues, and bulging around the disc. Some anatomical factors, such as the enlarged, weakened bones caused by Paget's disease, can complicate both the degenerative process and treatment.

How is stenosis treated?

There are three basic treatment approaches to spinal stenosis: the conservative medical approach, which frequently involves bed rest, analgesics, local heat, and muscle relaxants; the conservative chiropractic approach, which includes manipulation, exercise and self-care techniques; and surgery. The source of the stenosis often dictates the treatment.

Although medications can provide pain relief, those powerful enough to deaden the pain can also exacerbate patients' already compromised sense of balance. When the patient loses bowel or bladder control, suffers from intolerable leg pain and claudication, and has progressive loss of function or spinal cord tumors, surgery is the first and only option. The standard stenosis surgical procedure usually involves opening up the spinal canal and decompressing the neural elements by removing the bony structures that contribute to canal narrowing. Although many patients do fairly well after the surgery, the symptoms are likely to return after a period of time.

Recent studies show that although stenosis surgery will often have good results up to two years, in the long run, outcomes are much the same between surgery and conservative care. Some surgeries have to be repeated years later. Many are far from fully satisfactory. Surgery is a complicated procedure that irreversibly changes the structure of the back.

In many mild and moderate cases of stenosis, however, non-invasive conservative care, such as chiropractic, can help lessen pain and discomfort, maintain joint mobility, and allow the patient to keep a reasonable lifestyle, at least for some time.

A technique called distraction manipulation may be helpful in reducing leg discomfort.

Home exercises are a major part of the conservative treatment program. Recommended four or five times a week, the exercises, such as bicycle riding or lying on the side and grasping the knees with the arms, focus on flexing the spine in a forward position—stretching and strengthening the lower back and stomach muscles and improving muscle strength. Exercises designed to mobilize the involved nerves have been found to be particularly helpful.

Ultimately, stenosis is a chronic condition that cannot be "cured," but it often can be improved, and improvement can be maintained over the long term. Patients can work with a health care provider, such as a doctor of chiropractic, to reduce symptoms and improve their quality of life.

Signs and Symptoms of Stenosis:

• Pseudoclaudication—pain triggered by walking or prolonged standing, which is usually improved by sitting in a forward leaning flexed position
• Numbness, tingling, and hot or cold feelings in the legs
• Muscle weakness and spasms

Does it hurt when you chew, open wide to yawn or use your jaws? Do you have pain or soreness in front of the ear, in the jaw muscle, cheek, the teeth or the temples? Do you have pain or soreness in your teeth? Do your jaws make noises loud enough to bother you or others? Do you find it difficult to open your mouth wide? Does your jaw ever get stuck/locked as you open it?

If you answered "yes" to some of these questions, you may have a temporomandibular joint disorder, or TMD.

TMD is a group of conditions, often painful, that affect the jaw joint. Signs may include:

• Radiating pain in the face, neck, or shoulders;
• Limited movement or locking of the jaw;
• Painful clicking or grating when opening or closing the mouth;
• A significant change in the way the upper and lower teeth fit together;
• Headaches, earaches, dizziness, hearing problems and difficulty swallowing.

For most people, pain or discomfort in the jaw muscles or joints is temporary, often occurs in cycles, and resolves once you stop moving the area. Some people with TMD pain, however, can develop chronic symptoms.

Your doctor of chiropractic can help you establish whether your pain is due to TMD and can provide conservative treatment if needed.

What Causes TMD?

Researchers agree that TMD falls into three categories:

• Myofascial pain—discomfort or pain in the muscles of the jaw, neck, and shoulders;
• A dislocated jaw or displaced disc;
• Degenerative joint disease—rheumatoid arthritis or osteoarthritis in the jaw joint.

Severe injury to the jaw is a leading cause of TMD. For example, anything from a hit in the jaw during a sporting activity to overuse syndromes, such as chewing gum excessively or chewing on one side of the mouth too frequently may cause TMD.

Both physical and emotional stress can lead to TMD, as well. The once-common practice of sitting in a dentist's chair for several hours with the mouth wide open may have contributed to TMD in the past. Now, most dentists are aware that this is harmful to the jaw. In addition to taking breaks while they do dental work, today's dentists also screen patients for any weaknesses in the jaw structure that would make physical injury likely if they keep their mouths open very long. In that case, they may use medications during the procedure to minimize the injury potential, or they may send

the patient to physical therapy immediately after treatment. In less severe cases, they instruct patients in exercises they can do at home to loosen up the joint after the visit.

While emotional stress itself is not usually a cause of TMD, the way stress shows up in the body can be. When people are under psychological stress, they may clench their teeth, which can be a major factor in their TMD.

Some conditions once accepted as causes of TMD have been dismissed—moderate gum chewing, non-painful jaw clicking, orthodontic treatment (when it does not involve the prolonged opening of the mouth, as mentioned above), and upper and lower jaws that have never fit together well. Popular theory now holds that while these may be triggers, they are not causes.

Women experience TMD four times as often as men. Several factors may contribute to this higher ratio, including sitting too long at the workplace, general posture and higher heels.

TMD Diagnosis and Treatment

To help diagnose or rule out TMD, your doctor of chiropractic (DC) may ask you to put three fingers in your mouth and bite down on them. You may also be asked to open and close your mouth and chew repeatedly while the doctor monitors the dimensions of the jaw joint and the balance of the muscles. If you have no problems while doing these things, then the problem is not likely to be TMD. Your DC can then look for signs of inflammation and abnormalities. Sometimes special imaging, an x-ray or an MRI may be needed to help confirm the diagnosis.

If you have TMD, your doctor may recommend chiropractic manipulation, massage, applying heat/ice and special exercises. In most cases, your doctor's first goal is to relieve symptoms, particularly pain. If your doctor of chiropractic feels that you need special appliances or splints (with the exception of the "water pack" and other guards against teeth grinding), he or she will refer you to a dentist or orthodontist for co-management. In addition to treatment, your doctor of chiropractic can teach you how to:

• Apply heat and ice to lessen the pain. Ice is recommended shortly after the injury or after your pain has started. In the later stages of healing, you need to switch to heat, especially if you are still experiencing discomfort.
• Avoid harmful joint movements. For example, chomping into a hard apple is just as bad as crunching into hard candy (some hard candies are even called "jawbreakers"—for good reason).

And giant sandwiches can cause the mouth to open too wide and have a destabilizing effect on the jaw.

• Perform TMD-specific exercises. Depending on your condition, your DC may recommend stretching or strengthening exercises. Stretching helps to loosen tight muscles and strengthening helps to tighten muscles that have become loose. Special feedback sensors in the jaw can be retrained, as well, if needed.

TMD and Surgery

In some cases, TMD may not respond to a conservative approach—for example, when there is a disc problem in the joint itself—and may require dental treatment or surgery. Remember, however, that surgery and other permanent, irreversible treatments should be considered as a last resort.

According to the National Institutes of Health, certain irreversible treatments, such as surgical replacement of jaw joints with artificial implants, may cause severe pain and permanent jaw damage.

Complications from artificial jaw-joint implants, for example, have led the Food and Drug Administration to recall certain implants.

What is Causing the Asthma Epidemic?

Patient Information from the American Chiropractic Association

In the United States, asthma cases have increased by more than 60 percent since the early 1980s, and asthma-related deaths have doubled to 5,000 a year. What

is causing the asthma epidemic and what can we do to stem the tide?

People in their 30s and older can remember that when they were young, it was very unusual for even one child in school to have asthma. Schoolchildren now often know several kids with asthma in a single class. The rapid increase in the number of young people with asthma was brought home to Dr. Scott Bautch, member of the American Chiropractic Association's (ACA) Council on Occupational Health, when he went to a football game with his 13-year-old son: "Someone on the field had a breathing problem. It was hard to see whose son it was, and 15 parents ran to the field with inhalers."

What Causes Asthma?

So far, researchers don't know why cases of asthma are increasing at such an alarming rate. They hypothesize that a combination of genetics and some nonhereditary factors— such as increased environmental exposure to potential allergens — plays a role. "Thirty years ago, Windex was the only cleaning solvent used by a few people. Now, we have a special cleaning solvent for every object," says Dr. Bautch. "In addition, furniture and carpets are produced with formaldehyde as a preservative, and people breathe it," he says. Decreased air quality is coupled with the allergy-friendly modern house design, says Dr. William E. Walsh, MD, FACC, an allergist practicing in Minnesota: "Fifty years ago we lived in old, drafty houses, and the breeze dried and freshened the air, and cleared out mold and other allergens. Nowadays, our super-insulated houses don't breathe adequately. Making basements into a living space increases mold exposure because mold grows in any basement."

Food has become another source of exposure to allergens. "Food manufacturers put more preservatives in foods now to store them longer," says Dr. Bautch. Researchers hypothesize that an increase in vaccinations, cesarean births, and antibiotic intake may be playing a role, too.

How Can Asthma Be Treated?

Asthma is a chronic disease; it can't be cured —only controlled. For best treatment results, both the primary care physician and an asthma specialist, such as an allergist or pulmonologist, should be involved. According to experts interviewed for the article, the treatment program, in addition to medication intake, should include reducing exposure to the substances that induce acute episodes and identifying specific allergens that affect the patient.

Non-Allergen Causes of Asthma

Allergens aren't the only culprit of asthma attacks. Stress factors — such as moving to a new home, or changing jobs — may induce or aggravate asthma attacks. Even emotional expressions such as fear, anger, frustration, hard crying, or laughing can cause an attack as well. To reduce the patient's stress level and improve the patient's quality of life, alternative treatments should be incorporated into the treatment program. Various relaxation techniques, such as biofeedback, meditation, yoga, and stress management, as well as massage, chiropractic manipulation, breathing exercises, and acupuncture can be helpful.

Chiropractic Care Can Help

"Doctors of chiropractic can give a full-scale evaluation to asthma patients; assess their physical and neurological status, their lifestyle, diet, and stressors; and help the patients increase motor coordination, and improve the work of respiratory and gut muscles to increase the quality of life," says Dr. Gail Henry, a chiropractic neurologist, who practices in Houston, Texas. "Doctors of chiropractic can be a great addition to the healthcare team treating the asthma patient."

Talk to your doctor of chiropractic about other ways to improve your quality of life. Doctors of chiropractic are trained and licensed to examine and treat the entire body with emphasis on the nervous and musculoskeletal systems. They also help people lead healthier lives by focusing on wellness and prevention.

Tips to Alleviate Asthma Symptoms

• Use air filters to help clean air in your home.
• Cover mattresses and pillows with dust covers and use hypoallergenic bed clothing to reduce exposure to dust mites.
• Get checked for viral respiratory infections and different medical conditions, such as flu, rhinitis, sinusitis, and gastroesophageal reflux. Endocrine factors, such as menstruation, pregnancy, and thyroid disease, may exacerbate asthma, as well.
• Some medications—aspirin; beta-blockers, including eye drops; nonsteroidal anti-inflammatory drugs, etc.—can also precipitate or aggravate asthma symptoms.
• If your asthma is exercise-induced, an individually prescribed exercise program carefully chosen under the guidance of your primary health care provider or doctor of chiropractic should be incorporated into the treatment plan.
• Avoid sulfites or monosodium glutamate (MSG) in foods. Since both additives are used in a wide variety of foods, carefully read processed food labels and choose MSG-free foods when eating out.
• Choose a more vegetarian-type diet. Animal proteins found in meat include arachidonic acid—a precursor for inflammation.
• Include foods with omega-3 fatty acids in the diet—such as fish or fish oil.
• Supplement with vitamin C, which helps reduce allergic reactions and wheezing.
• To reduce stress in your children, spend quality time with them and limit their exposure to TV programs that include violence.

Headaches are more common in adults, although they can develop at any time in life. Approximately 4 out of 5 children have headaches at some point, but most are benign and self-resolving. In fact, many adults who suffer from headaches report having the first headache in childhood.

Headache symptoms usually begin gradually. In fact, the sudden onset of severe headache may signify a serious problem and requires immediate medical attention. Common headache is often described as achy, dull or throbbing pain. It typically begins at the base of the skull/upper part of the neck and may radiate into the eye(s), the temple, or other locations. Headaches may be felt on one or both sides of the head. Often loud noises or bright lights may make them worse. Some patients may become nauseated or experience odd smells, sounds, or sights before and during the headache attack.

How Is a Headache Evaluated?

Early diagnosis and treatment are important in identifying a serious underlying cause for your headache. In most cases, an in-depth history and physical examination can help determine if your symptoms are related to an easily treated problem, or if it is more serious. Your doctor can use other tests that reproduce the symptoms of your headache to help develop a specific management plan for your condition, or refer you to another health care provider. X-rays, laboratory tests and even advanced imaging studies like magnetic resonance imaging (MRI) may be necessary. Your doctor

may ask you to complete a headache diary, recording:

• day and time of the headache
• headache location
• what the headache feels like
• what you were doing when the headache began
• how long the headache lasts
• what makes it feel better or worse
• anything else you notice before, during, or after the attacks

What Is the Treatment for Headaches?

Headache treatment is cause-related. Doctors of chiropractic often treat patients with tension-type headaches and headaches caused by problems with the joints and muscles in the neck, as well.

Joint manipulation and mobilization of the neck, along with stretching and strengthening exercises, have been demonstrated to be effective in the treatment of this type of headache.

Massage and other forms of soft-tissue treatment can sometimes be helpful. Scientists are also investigating other therapies, such as acupuncture, to prevent and treat this disorder.

Over-the-counter pain relievers, such as acetaminophen, can be used for an occasional headache, but not for long-term headache management.

More serious causes of headache require aggressive treatment, and your doctor of chiropractic can assist you in finding a medical headache specialist.

The majority of patients with headache recover completely after treatment. Unfortunately, the recurrence rate is relatively high, particularly with tension-type headache. If you have any questions or concerns about headache, feel free to discuss them with your doctor or chiropractic.

What Causes Headaches?

Headaches can be primary and secondary. Primary headaches do not result from some other health condition. The most common type of primary headache is caused by problems with the neck muscles. Changes in the blood vessels inside the skull usually cause migraines. Other common types of headache include "cluster" headaches—headaches grouped together over weeks at a time; sinus headaches, associated with allergies and/or sinus infection; and headaches from poor vision.

Secondary headache results from some other cause or condition—head injury, concussion, blood vessel problems, or high blood pressure—or from side effects of some medications, infections in the head or sinuses or elsewhere in the body. Rare headache causes include tumors, aneurysms and other abnormal growths inside the skull, and toxic substances in the blood. Certain foods, such as monosodium glutamate (MSG), a food flavor enhancer, may cause headaches, as well.

How Can Headaches Be Prevented?

Muscle-tension headaches can often be avoided by maintaining proper posture and neck movements while performing your normal activities. You should:

• Avoid slouching
• Avoid reading with your neck bent forward
• Keep your computer monitor at eye level
• Take frequent breaks from reading and working on the computer.
• Try a low-fat, high-complex carbohydrate diet.

A recent study demonstrated that such a diet can dramatically lower the frequency, intensity, and\duration of migraine headaches.

What are the signs of a serious headache?

You should call your doctor and/or seek emergency care if:

• You have a stiff neck and a fever along with your headache.
• It is painful to bend your head to your chest.
• Your speech is slurred.
• You have vision changes.
• You feel numbness or weakness in your arms or legs.
• Your headache lasts longer than 3 days.
• You recently injured your head and your headache will not go away.
• You often get headaches in the morning.
• You have a sudden headache although you normally don't have them.

Other signs of serious headache include:

• The worst headache you've ever had
• Worsening or more frequent headaches
• Headache that wakes you from sleep
• Personality changes along with headache
• Early morning vomiting without headache.

People with vertigo know that the law of gravity prevails, but their brains get confused. They feel like they are tilting in space, or that the world is spinning or moving around them. Nausea, sweating, headaches, vomiting, and fatigue may add to their discomfort.

What Is vertigo?

Vertigo is a type of dizziness. Dizziness is generally described as a floating feeling of instability or unsteadiness. Unlike other types of dizziness, vertigo—an illusion of movement when no movement takes place—is a sign that can be objectively tested. Some patients have overlapping signs and symptoms of vertigo plus lightheadedness or dizziness.

Causes of Vertigo

Most vertigo is caused by problems with the peripheral or central nervous system. Vertigo that originates in the peripheral nervous system is often connected with issues in the inner ear. Such causes of vertigo include benign paroxysmal positional vertigo (BPPV), acute vestibular neuronitis, labyrinthitis, and Menière's disease.

Vertigo related to the central nervous system is brought about by disorders of the brain or the spinal cord. Acoustic neuroma, migraines, and multiple sclerosis are included in this category, as is cervicogenic vertigo. Cardiovascular problems such as vertebrobasilar insufficiency are among vertigo's many possible sources, as well.

Vertigo can also be caused by a wide variety of medications such as antidepressants, anticonvulsants, antihypertensives, diuretics, barbiturates, salicylates (e.g., aspirin), and sedatives or hypnotics. Cocaine can cause vertigo, as can nitroglycerin, quinine, and some prescription and over the- counter cold medicines. Antibiotics that have been linked to vertigo include gentamicin and streptomycin, as well as antineoplastics such as cisplatin and carboplatin.

Metabolic issues—such as diabetes mellitus, hypothyroidism, high blood triglycerides, hypoglycemia, and food allergies/gluten sensitivity—can also cause or worsen vertigo. Other patients' vertigo can be traced to motor vehicle accidents, falls, or work-related and other types of traumas or illnesses.

Diagnosis and Treatment

To diagnose the cause of vertigo, your health care provider will perform an examination, including a variety of positioning tests, to check if they will reproduce the sensation of motion. Other tests may be necessary, as well.

Benign Paroxysmal Positional Vertigo (BPPV)

About 65 percent of vertigo is caused by BPPV—a result of calcium debris in the inner ear. The Epley maneuver—a procedure in which the patient is rapidly moved from lying on one side to lying on the other in order to move the calcium debris to a less-sensitive location in the inner ear— helps the majority of patients with BPPV. Studies show that up to 80 percent of patients recover after a single treatment with the Epley maneuver, and most BPPV cases respond to two to three Epley treatments.

BPPV, however, has a tendency to recur. About 15 percent of patients will experience BPPV again within 12 months of the first episode; in 20 percent, BPPV comes back after 20 months, and in 37 percent, after 60 months. In addition, the Epley maneuver is contraindicated in patients with severe carotid stenosis, heart diseases, and severe neck problems, such as cervical spondylosis with myelopathy or advanced rheumatoid arthritis.

Even without treatment, BPPV tends to resolve in weeks or months. Your doctor can also recommend vestibular rehabilitation exercises (called the Brandt-Daroff exercises after the name of their inventor) for you to perform at home. Each exercise position should be maintained for 30 seconds if there is no vertigo—or for 30 seconds beyond the point where the vertigo stops. The exercises should be repeated five to 10 times and performed three times a day for four to six weeks.

Other Types of Vertigo

Treatment for vertigo caused by other conditions depends on the individual case. Ménière's disease patients, for example, can benefit from a low-salt diet. Treatment for vertigo associated with migraine headaches should include dietary changes, such as reduction or elimination of aspartame, chocolate, alcohol and caffeine. A regular program of exercise, reducing stress, getting adequate sleep, and performing vestibular rehabilitation exercises can also help reduce symptoms. Vestibular neuronitis and

labyrinthitis, which are often attributed to viral infections, can also be treated with vestibular exercises. In chronic or seriously disabling cases of vertigo, a short course of vestibular-suppressing medications can help provide temporary relief.

Working with your doctor of chiropractic to improve postural issues can also bring relief to patients whose vertigo is exacerbated by a sedentary lifestyle or working in certain positions for extended periods. Flexed positions—such as those assumed by dentists or dental assistants—can compromise extensor muscles and cause postural imbalances, which may result in vertigo. To restore balance, volleyball, basketball, and other sports involving the extensor muscles may be helpful. In patients with cervicogenic vertigo, a general ergonomic assessment of work and life activities can help identify contributors to the problem.

Nutrition and Stress Reduction

A balanced diet can provide nutrients necessary for proper function of organs and restore nutrient imbalances, some of which may contribute to vertigo.

In addition, some supplements and herbs may be helpful in reducing vertigo:

• Vinpocetine may help balance the sodium channel in the brain and prevent inflammation.
• Vitamin B6 has been shown to be effective with nausea and may also help with vertigo.
• Ginkgo biloba has been shown to reduce vertigo symptoms in a few studies.
• Fish oils improve the cognitive function and may also be helpful—especially when vertigo is caused by a brain dysfunction problem.
• Chromium (at least 200 mcg a day) may be helpful in patients whose vertigo is caused by a blood sugar imbalance. Good dietary sources of chromium are brewer's yeast and barley flour. Refined sugars, white flour products, and lack of exercise can deplete chromium.

Excessive stress exacerbates many conditions, and vertigo is no exception. Physical exercise and meditation, adequate sleep and other stress reduction techniques can all help contribute to recovery from vertigo and should be a part of the treatment regimen. At Ash Chiropractic and Wellness, we can help create an appropriate exercise program for you and counsel you regarding healthy lifestyle and stress

RED FLAGS
Vertigo patients who present with the following signs should go immediately to the emergency room:

• double vision
• headache
• weakness
• difficulty speaking
• difficulty waking up or staying awake
• difficulty walking
• inappropriate actions
• difficulty controlling arms or legs
• abnormal eye movements

Nystagmus, which is characterized by uncontrollable, rhythmic, or jerky eye movements, is one of the signs of BPPV. However, additional diagnostic tests and/or ear, nose, and throat or neurological evaluations should be done in patients who have nystagmus to rule out possibly harmful structural causes.

The signs and symptoms of whiplash often do not develop until 2 to 48 hours after the injury.

Whiplash is a generic term applied to injuries of the neck caused when the neck is suddenly and/or violently jolted in one direction and then another, creating a whip like movement. Whiplash is most commonly seen in people involved in motor vehicle accidents, but it can also occur from falls, sports injuries, work injuries, and other incidents.

Most whiplash injuries are associated with forward and backward movement of the head and neck on the shoulders. Side-impact crashes, in which a person's head is turned, may result in side-to-side or even oblique whiplash-style injuries to the neck.

Although severe whiplash injuries can result in paralysis and even death, most such injuries are relatively mild.

What structures are injured in a whiplash?

Whiplash injuries most often result in sprain-strain of the neck. The ligaments that help support, protect, and restrict excessive movement of the vertebrae are torn, which is called a sprain. The joints in the back of the spine, called the facet joints, are covered by ligaments called facet capsules, which seem to be particularly susceptible to whiplash injury.

In addition, the muscles and tendons are strained— stretched beyond their normal limits. The discs between the vertebrae, which are essentially ligaments, can be torn, potentially causing a disc herniation. The nerve roots between the vertebrae may also be stretched and become inflamed. Even though it is very rare, vertebrae can be fractured and/or dislocated in a whiplash injury.

What are the common signs and symptoms of whiplash?

Approximately two thirds of people involved in motor vehicle accidents develop symptoms of whiplash. Interestingly, the violence of the crash is not a definitive indicator of pain or even the amount of pain. Generally speaking, however, those involved in more severe accidents have more signs and symptoms.

Another important and interesting aspect of whiplash is that the signs and symptoms often do not develop until 2 to 48 hours after the injury. This scenario is relatively common but not completely understood. Some speculate that it may be due to delayed muscle soreness, a condition seen in other circumstances.

The most common symptoms of whiplash are pain and stiffness in the neck. These symptoms are generally found in the areas that are "whiplashed." For example, during a whiplash, first the head is lifted up from the upper-cervical spine. This creates a sprain/strain in the region just below the skull, where symptoms usually occur. Symptoms may also commonly be seen in the front and back of the neck. Turning the head often makes the pain and discomfort worse.

Headache, especially at the base of the skull, is also a common symptom, seen in more than two thirds of patients. These headaches may be one-sided (unilateral) or experienced on both sides (bilateral). In addition, the pain and stiffness may extend down into the shoulders and arms, upper back, and even the upper chest.

In addition to the musculoskeletal symptoms, some patients also experience dizziness, difficulty swallowing, nausea, and even blurred vision after a whiplash injury. While these symptoms are disconcerting, in most cases, they disappear within a relatively short time. If they persist, it is very important to inform your doctor that they are not resolving. Vertigo (the sensation of the room spinning) and ringing in the ears may also be seen. In addition, some patients may feel pain in the jaw. Others will even complain of irritability, fatigue, and difficulty concentrating. These symptoms also resolve quickly in most cases. In rare cases, symptoms can persist for weeks, months, or even years.

How is whiplash diagnosed?

To make a diagnosis, a thorough history of the injury and the patient's previous medical history are taken. Preexisting conditions, such as arthritis and/or previous injury, may increase the severity of the signs and symptoms of whiplash. Following history-taking, an in-depth physical examination, with concentration on the neuromusculoskeletal system, is performed. When appropriate, X-rays of the neck may be taken. If the doctor suspects that the soft tissues (for example, discs or ligaments) in the neck are injured, more advanced imaging studies, such as magnetic resonance imaging (MRI), may be ordered.

How is whiplash treated?

Staying active
One of the most important aspects of whiplash management is for the patient to stay active, unless there is some serious injury that requires immobilization. Patients should not be afraid to move and be active, within reason. In addition, your doctor will often prescribe an exercise or stretching program. It is particularly important to follow this program as prescribed, so that you can achieve the best long-term benefits.

Soft-cervical collar
The use of a soft-cervical collar remains controversial. Some suggest that such devices are inappropriate, as they act as a "crutch" and encourage a patient to avoid activity. Others suggest that, with proper counseling, a collar can help a patient slowly return to normal activities. There is no controversy, however, when discussing the length of time that a soft collar should be worn—no more than one week.

Chiropractic manipulation and physical therapy
Ice and/or heat are often used to help control pain and reduce the muscle spasm that results from whiplash injuries. Other physical therapy modalities, such as electrical stimulation and/or ultrasound, may provide some short-term relief. They should not, however, replace an active-care program of exercise and stretching. Spinal manipulation and/or mobilization provided by a chiropractor can also give relief in many cases of neck pain.

Surgery and injections
Surgery, injections, and other invasive options are rarely necessary but are available, when appropriate. They are generally reserved for patients with more severe injuries to the discs, vertebrae, and nerves in the neck region.

Can whiplash be prevented?

Generally speaking, whiplash cannot be "prevented," but there are some things that you can do while in a motor vehicle that may reduce the chances of a more severe injury. Always wear restraints (lap or shoulder belt), and ensure that the headrest in your vehicle is adjusted to the appropriate height.